Mental Stress-Induced Change in Plasma Stromal Cell-Derived Factor-1 and Adverse Cardiovascular Outcomes: A Cohort Study.
Mental Stress-Induced Change in Plasma Stromal Cell-Derived Factor-1 and Adverse Cardiovascular Outcomes: A Cohort Study.
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DOI：
10.1016/j.cjco.2023.01.006
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发表时间：
2023-04
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影响因子：
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通讯作者：
Quyyumi, Arshed A
中科院分区：
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作者：
Kim, Jeong Hwan;Almuwaqqat, Zakaria;Martini, Afif;Liu, Chang;Ko, Yi-An;Sullivan, Samaah;Dong, Tiffany;Shah, Amit J;Bremner, J Douglas;Pearce, Brad D;Nye, Jonathan A;Vaccarino, Viola;Quyyumi, Arshed A
急性心理应激可引起冠心病患者的心理应激性心肌缺血。基质细胞衍生因子1（SDF 1）在缺氧时释放，较高水平的SDF 1与不良结局相关。我们研究了在CAD患者中，SDF 1水平的增加是否对精神压力的反应预示着不良结局。共有554例稳定型CAD患者（平均年龄63岁; 76%为男性; 26%为黑人）接受了标准化精神压力测试。在安静和精神应激后90分钟测量血浆SDF 1水平，并通过99 mTc-sestamibi灌注成像评估MSIMI。参与者被随访5年，主要终点为死亡和心肌梗死（MI）的复合终点，次要终点为死亡、MI和心力衰竭住院的复合终点。考克斯风险模型用于评估SDF 1变化与不良事件发生之间的关联。心理应激的平均（标准差）SDF 1变化为+56.0（230）pg/mL。在随访期间，精神压力下SDF 1标准差增加1与死亡和MI的主要终点风险增加32%相关（95%置信区间，6%-64%），与静息SDF 1水平、人口统计学和临床风险因素以及缺血的存在无关。SDF 1标准差增加1个与次要终点风险增加33%（95%置信区间，11%-59%）相关，与静息SDF 1水平、人口统计学和临床风险因素以及缺血的存在无关。在稳定型CAD患者中，对精神压力反应的SDF 1水平升高与不良事件的风险升高相关，与MSIMI无关。
Acute psychological stress can provoke mental stress-induced myocardial ischemia (MSIMI) in coronary artery disease (CAD). Stromal cell-derived factor 1 (SDF1) is released in response to hypoxia, and higher levels of SDF1 are associated with adverse outcomes. We examined whether an increase in SDF1 level in response to mental stress predicts adverse outcomes in CAD patients. A total of 554 patients with stable CAD (mean age 63 years; 76% male; 26% Black) underwent standardized mental stress testing. Plasma SDF1 levels were measured at rest and 90 minutes after mental stress, and MSIMI was evaluated by 99mTc-sestamibi perfusion imaging. Participants were followed for 5 years for the primary endpoint of composite of death and myocardial infarction (MI) and the secondary endpoint of composite of death, MI, and heart failure hospitalization. Cox hazard models were used to assess the association between SDF1 change and incident adverse events. Mean (standard deviation) SDF1 change with mental stress was +56.0 (230) pg/mL. During follow-up, a rise of 1 standard deviation in SDF1 with mental stress was associated with a 32% higher risk for the primary endpoint of death and MI (95% confidence interval, 6%-64%), independent of the resting SDF1 level, demographic and clinical risk factors, and presence of ischemia. A rise of 1 standard deviation in SDF1 was associated with a 33% (95% confidence interval, 11%-59%) increase in the risk for the secondary endpoint, independent of the resting SDF1 level, demographic, and clinical risk factors and presence of ischemia. An increase in SDF1 level in response to mental stress is associated with a higher risk of adverse events in stable CAD, independent of MSIMI.